Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.

Measurement of Pain Perception in Children and Adolescents with Musculoskeletal Pain.

Fraga1,  Melissa, Len1,  Claudio A., Azevedo1,  Rafael, Yoguim1,  Marcelo I., Terreri2,  Maria Teresa, Hilario1,  Maria Odete E.

Universidade Federal de São Paulo/UNIFESP, São Paulo, Brazil
Universidade Federal de São Paulo/UNIFESP, Sao Paulo, Brazil


The fact that musculoskeletal pain in childhood and adolescence is related to physical, emotional, familiar and cultural factors make both diagnosis and treatment real challenges in pediatric rheumatology. Therefore, the approach must be individual and based in the perception of each patient. Our aim was to measure the individual perception in hypothetical situations related to physical pain, emotional pain (deprivation of the company) and pain related to medical procedures.


We evaluated pain perception in 150 children and adolescents (8–18 years), that were included in 3 distinct groups: 50 with polyarticular juvenile idiopathic arthritis (JIA), 50 with idiopathic musculoskeletal pain (IMP) and 50 healthy children (without clinical history of chronic or recent acute pain). Pain perception was measured by 3 vignettes that illustrated life situations related to pain: physical trauma (bicycle fall), medical procedure (needle injection) and social isolation; the scores were measured by a 100 mm visual analogical scale (VAS). The evaluation also included 3 questionnaires: CHAQ, PedsQL 4.0) and the Pediatric Pain Coping Inventory (PPCI).


JIA patients presented worse physical ability (measured by the CHAQ) when compared to IMP patients (p<0,0001). On the other hand, we observed lower scores in the IMP group in all aspects of health related quality of life (p<0,0001), including the physical domain. Concerning individual perception of pain, children and adolescents with IMP presented higher scores in the 3 pain situations (p<0,0001). With respect to pain coping, the 5-factor solution of the PPCI (cognitive self-instruction, seek social support, strive to rest and be alone, cognitive refocusing and problem-solving self-efficacy), children with IMP had worse scores in all of them, excluding cognitive self-instruction (p<0,001).


Our data reinforce the belief that the treatment of musculoskeletal pain should be performed by a multidisciplinary team, not just based on the use of analgesics. The perception has pain is personal and involves physical, emotional and social aspects. We also conclude that a focused education is required for pain coping, once the attitudes taken by children and adolescents in the presence of pain are not always for its control.

To cite this abstract, please use the following information:
Fraga, Melissa, Len, Claudio A., Azevedo, Rafael, Yoguim, Marcelo I., Terreri, Maria Teresa, Hilario, Maria Odete E.; Measurement of Pain Perception in Children and Adolescents with Musculoskeletal Pain. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :2403

Abstract Supplement

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